PENGUIN BOOKS

THE DIVIDED SELF

R. D. Laing, one of the best-known psychiatrists of moderntimes, was born in Glasgow in 1927 and graduated fromGlasgow University as a doctor of medicine. In the 1960s hedeveloped the argument that there may be a benefit inallowing acute mental and emotional turmoil in depth to goon and have its way, and that the outcome of such turmoilcould have a positive value. He was the first to put such astand to the test by establishing, with others, residenceswhere persons could live and be free to let happen what willwhen the acute psychosis is given free rein, or where, at thevery least, they receive no treatment they do not want. Thiswork with the Philadelphia Association since 1964, togetherwith his focus on disturbed and disturbing types ofinteraction in institutions, groups and families, has beenboth influential and continually controversial.

R. D. Laing's writings range from books on social theory toverse, as well as numerous articles and reviews in scientificjournals and the popular press. His publications are: TheDivided Self, Self and Others, Interpersonal Perception(with H. Phillipson and A. Robin Lee), Reason andViolence (introduced by Jean-Paul Sartre), Sanity, Madnessand the Family (with A. Esterson), The Politics ofExperience and The Bird of Paradise, Knots, The Politics ofthe Family, The Facts of Life, Do You Love Me?,Conversations with Children, Sonnets, The Voice ofExperience and Wisdom, Madness and Folly.

R. D. Laing died in 1989. Anthony Clare, writing in theGuardian, said of him: 'His major achievement was that hedragged the isolated and neglected inner world of theseverely psychotic individual out of the back ward of thelarge gloomy mental hospital and on to the front pages ofinfluential newspapers, journals and literary magazines . . .Everyone in contemporary psychiatry owes something toR. D. Laing.'

R. D. Laing

The Divided SelfAn Existential Study in Sanity and Madness

Penguin Books

PENGUIN BOOKS

Published by the Penguin Group

Penguin Books Ltd, 27 Wrights Lane, London W8 5TZ, EnglandPenguin Books USA Inc., 375 Hudson Street, New York, New York 10014, USA

Penguin Books Australia Ltd, Ringwood, Victoria, Australia

Penguin Books Canada Ltd, 10 Alcom Avenue, Toronto, Ontario, Canada M4V 3B2

Penguin Books (NZ) Ltd, 182-190 Wairau Road, Auckland 10, New Zealand

Penguin Books Ltd, Registered Offices: Harmondsworth, Middlesex, England

First published by Tavistock Publications (1959) Ltd 1960

First published in the USA by Pantheon Books Inc 1962

Published in Pelican Books 1965

Reprinted in Penguin Books 1990

10 9 8 7 6 5 4 3

Copyright © Tavistock Publications (1959) Ltd, 1960Preface to Pelican edition copyright © R. D. Laing, 1965Copyright © R. D. Laing, 1969All rights reserved

Printed in England by Clays Ltd, St Ives plcSet in Monotype Times

Except in the United States of America, this book is sold subjectto the condition that it shall not, by way of trade or otherwise, be lent,re-sold, hired out, or otherwise circulated without the publisher'sprior consent in any form of binding or cover other than that inwhich it is published and without a similar condition including thiscondition being imposed on the subsequent purchaser

To my mother and father

Contents

1

2

3

4

5

6

7

8

9

10

11

Preface to the Original Edition 9

Preface to the Pelican Edition 11

Acknowledgements 13

Part One

The existential-phenomenological foundations for a

science of persons 17

The existential-phenomenological foundations for

the understanding of psychosis 27

Ontological insecurity 39

Part Two

The embodied and unembodied self 65

The inner self in the schizoid condition 78

The false-self system 94 Self-consciousness

106

The case of Peter 120

Part Three

Psychotic developments 137

The self and the false self in a schizophrenic 160

The ghost of the weed garden: a study of a chronic

schizophrenic 178

References 207

Index 211

Preface to the Original Edition

This is the first of a series of studies in existential psychology and

psychiatry, in which it is proposed to present original contributions

to this field by a number of authors.

The present book is a study of schizoid and schizophrenic per-

sons; its basic purpose is to make madness, and the process of

going mad, comprehensible. Readers will judge variously the

success or failure of this aim. I would ask, however, that the book

should not be judged in terms of what it does not attempt to do.

Specifically, no attempt is made to present a comprehensive theory

of schizophrenia. No attempt is made to explore constitutional

and organic aspects. No attempt is made to describe my own

relationship with these patients, or my own method of therapy.

A further purpose is to give in plain English an account, in exis-

tential terms, of some forms of madness. In this I believe it to be the

first of its kind. Most readers will find a few terms strangely used

in the first few chapters. I have, however, given careful thought to

any such usage, and have not employed it unless I felt compelled

by the sense to do so.

Here again, a brief statement about what I have not tried to do

may avoid misunderstanding. The reader versed in existential and

phenomenological literature will quickly see that this study is not

a direct application of any established existential philosophy.

There are important points of divergence from the work of

Kierkegaard, Jaspers, Heidegger, Sartre, Binswanger, and Tillich,

for instance.

To discuss points of convergence and divergence in any detail

would have taken me away from the immediate task. Such a

10 Preface to the Original Edition

discussion belongs to another place. It is to the existential tradition,

however, that I acknowledge my main intellectual indebtedness.

I wish to express here my gratitude to the patients and their

parents about whom I have written in the following pages. All of

those to whom I have referred at any length have given their willing

consent to this publication. Names, places, and all identifying

details have been changed, but the reader can be assured that he is

not reading fiction.

I wish to register my gratitude to Dr Angus MacNiven and

Professor T. Ferguson Rodger for the facilities they provided for

the clinical basis for this study and the encouragement they gave

me.

The clinical work upon which these studies are based was all

completed before 1956, that is, before I became an assistant physi-

cian at the Tavistock Clinic, when Dr J. D. Sutherland generously

made secretarial help available in the preparation of the final

manuscript. Since the book was completed in 1957 it has been read

by many people, and I have received much encouragement and

helpful criticism from more individuals than I can conveniently

list. I would like to thank particularly Dr Karl Abenheimer, Mrs

Marion Milner, Professor T. Ferguson Rodger, Professor J.

Romano, Dr Charles Rycroft, Dr J. Schorstein, Dr J. D. Suther-

land, and Dr D. W. Winnicott for their constructive 'reactions' to

the MS.

R. D. LAING

Preface to the Pelican Edition

One cannot say everything at once. I wrote this book when I was

twenty-eight. I wanted to convey above all that it was far more pos-

sible than is generally supposed to understand people diagnosed as

psychotic. Although this entailed understanding the social context,

especially the power situation within the family, today I feel that,

even in focusing upon and attempting to delineate a certain type of

schizoid existence, I was already partially falling into the trap I was

seeking to avoid. I am still writing in this book too much about

Them, and too little of Us.

Freud insisted that our civilization is a repressive one. There is

a conflict between the demands of conformity and the demands of

our instinctive energies, explicitly sexual. Freud could see no easy

resolution of this antagonism, and he came to believe that in our

time the possibility of simple natural love between human beings

had already been abolished.

Our civilization represses not only 'the instincts', not only sexu-

ality, but any form of transcendence. Among one-dimensional

men,* it is not surprising that someone with an insistent experience

of other dimensions, that he cannot entirely deny or forget, will run

the risk either of being destroyed by the others, or of betraying

what he knows.

In the context of our present pervasive madness that we call

normality, sanity, freedom, all our frames of reference are am-

biguous and equivocal.

A man who prefers to be dead rather than Red is normal. A man

* See recently, Herbert Marcuse, One-Dimensional Man, Beacon Press,1964.

12 Preface to the Pelican Edition

who says he has lost his soul is mad. A man who says that men are

machines may be a great scientist. A man who says he is a machine

is 'depersonalized' in psychiatric jargon. A man who says that

Negroes are an inferior race may be widely respected. A man who

says his whiteness is a form of cancer is certifiable.

A little girl of seventeen in a mental hospital told me she was

terrified because the Atom Bomb was inside her. That is a delu-

sion. The statesmen of the world who boast and threaten that they

have Doomsday weapons are far more dangerous, and far more

estranged from 'reality' than many of the people on whom the

label 'psychotic' is affixed.

Psychiatry could be, and some psychiatrists are, on the side of

transcendence, of genuine freedom, and of true human growth.

But psychiatry can so easily be a technique of brainwashing, of

inducing behaviour that is adjusted, by (preferably) non-injurious

torture. In the best places, where straitjackets are abolished, doors

are unlocked, leucotomies largely forgone, these can be replaced

by more subtle lobotomies and tranquillizers that place the bars of

Bedlam and the locked doors inside the patient. Thus I would wish

to emphasize that our 'normal' 'adjusted' state is too often the

abdication of ecstasy, the betrayal of our true potentialities, that

many of us are only too successful in acquiring a false self to adapt

to false realities.

But let it stand. This was the work of an old young man. If I am

older, I am now also younger.

London September 1964

Acknowledgements

Thanks are due to the author and to Grune & Stratton for permis-

sion to quote from Meaning and Content of Sexual Perversions, by

Medard Boss; to George Allen & Unwin in respect of The Pheno-

menology of Mind, by Hegel, translated by J. B. Baillie; to Baillière,

Tindall & Cox in respect of Lectures on Clinical Psychiatry, by

E. Kraepelin; to The Hogarth Press and the Institute of Psycho-

Analysis in respect of Beyond the Pleasure Principle, by Sigmund

Freud, from The Complete Psychological Works of Sigmund Freud,

Vol. XVIII; to Rider & Co., London, in respect of The Analysis of

Dreams, by Medard Boss, and The Psychology of Imagination, by

Jean-Paul Sartre; and to Martin Secker & Warburg in respect of

The Opposing Self, by Lionel Trilling.

The author wishes to thank Dr M. L. Hayward and Dr J. E.

Taylor for their kind permission to quote at some length in Chap-

ter 10 from their paper 'A Schizophrenic Patient Describes the

Action of Intensive Psychotherapy', which appeared in the

Psychiatric Quarterly, 30, 211-66.

Je donne une œuvre subjective ici, œuvre cependant

qui tend de toutes ses forces vers L'objectivité.

E. MINKOWSKI

Part 1

The existential-phenomenological

foundations for a science of persons

The term schizoid refers to an individual the totality of whose

experience is split in two main ways: in the first place, there is a rent

in his relation with his world and, in the second, there is a disrup-

tion of his relation with himself. Such a person is not able to experi-

ence himself 'together with' others or 'at home in' the world, but,

on the contrary, he experiences himself in despairing aloneness and

isolation; moreover, he does not experience himself as a complete

person but rather as 'split' in various ways, perhaps as a mind more

or less tenuously linked to a body, as two or more selves, and so on.

This book attempts an existential-phenomenological account of

some schizoid and schizophrenic persons. Before beginning this

account, however, it is necessary to compare this approach to that

of formal clinical psychiatry and psychopathology.

Existential phenomenology attempts to characterize the nature

of a person's experience of his world and himself. It is not so much

an attempt to describe particular objects of his experience as to set

all particular experiences within the context of his whole being-in-

his-world. The mad things said and done by the schizophrenic will

remain essentially a closed book if one does not understand their

existential context. In describing one way of going mad, I shall try

to show that there is a comprehensible transition from the sane

schizoid way of being-in-the-world to a psychotic way of being-in-

the-world. Although retaining the terms schizoid and schizophrenic

for the sane and psychotic positions respectively, I shall not, of

course, be using these terms in their usual clinical psychiatric frame

of reference, but phenomenologically and existentially.

The clinical focus is narrowed down to cover only some of the

1

18 The Divided Self

ways there are of being schizoid or of going schizophrenic from a

schizoid starting-point. However, the account of the issues lived

out by the individuals studied in the following pages is intended to

demonstrate that \hese issues cannot be grasped through the

methods of clinical psychiatry and psychopathology as they stand

today but, on the contrary, require the existential-phenomeno-

logical method to demonstrate their true human relevance and

significance.

In this volume I have gone as directly as possible to the patients

themselves and kept to a minimum the discussion of the historical,

theoretical, and practical issues raised particularly vis-à-vis

psychiatry and psycho-analysis. The particular form of human

tragedy we are faced with here has never been presented with suffi-

cient clarity and distinctness. I felt, therefore, that the sheer

descriptive task had to come before all other considerations. This

chapter is thus designed to give only the briefest statement of the

basic orientation of this book necessary to avoid the most disas-

trous misunderstandings. It faces in two directions: on the one

hand, it is directed to psychiatrists who are very familiar with the

type of 'case' but may be unused to seeing the 'case' qua person as

described here; on the other hand, it is addressed to those who are

familiar with or sympathetic to such persons but who have not

encountered them as 'clinical material'. It is inevitable that it will

be somewhat unsatisfactory to both.

As a psychiatrist, I run into a major difficulty at the outset: how

can I go straight to the patients if the psychiatric words at my dis-

posal keep the patient at a distance from me? How can one demon-

strate the general human relevance and significance of the patient's

condition if the words one has to use are specifically designed to

isolate and circumscribe the meaning of the patient's life to a par-

ticular clinical entity ? Dissatisfaction with psychiatric and psycho-

analytic words is fairly widespread, not least among those who

most employ them. It is widely felt that these words of psychiatry

and psycho-analysis somehow fail to express what one 'really

means'. But it is a form of self-deception to suppose that one can

say one thing and think another.

It will be convenient, therefore, to start by looking at some of the

Foundations for a science of persons

words in use. The thought is the language, as Wittgenstein has put

it. A technical vocabulary is merely a language within a language.

A consideration of this technical vocabulary will be at the same

time an attempt to discover the reality which the words disclose or

conceal.

The most serious objection to the technical vocabulary currently

used to describe psychiatric patients is that it consists of words

which split man up verbally in a way which is analogous to the

existential splits we have to describe here. But we cannot give an

adequate account of the existential splits unless we can begin from

the concept of a unitary whole, and no such concept exists, nor can

any such concept be expressed within the current language system

of psychiatry or psycho-analysis.

The words of the current technical vocabulary either refer to

man in isolation from the other and the world, that is, as an entity

not essentially 'in relation to ' the other and in a world, or they

refer to falsely substantialized aspects of this isolated entity. Such

words are: mind and body, psyche and soma, psychological and

physical, personality, the self, the organism. All these terms are

abstracta. Instead of the original bond of I and You, we take a

single man in isolation and conceptualize his various aspects into

'the ego', 'the superego', and 'the id'. The other becomes either

an internal or external object or a fusion of both. How can we

speak in any way adequately of the relationship between me and

you in terms of the interaction of one mental apparatus with an-

other? How, even, can one say what it means to hide something

from oneself or to deceive oneself in terms of barriers between one

part of a mental apparatus and another? This difficulty faces not

only classical Freudian metapsychology but equally any theory

that begins with man or a part of man abstracted from his relation

with the other in his world. We all know from our personal experi-

ence that we can be ourselves only in and through our world and

there is a sense in which 'our ' world will die with us although ' the '

world will go on without us. Only existential thought has attempted

to match the original experience of oneself in relationship to others

in one's world by a term that adequately reflects this totality. Thus,

existentially, the concretum is seen as a man's existence, his being-

in-the-world. Unless we begin with the concept of man in relation

19

20 The Divided Self

to other men and from the beginning 'in' a world, and unless we

realize that man does not exist without 'his ' world nor can his

world exist without him, we are condemned to start our study of

schizoid and schizophrenic people with a verbal and conceptual

splitting that matches the split up of the totality of the schizoid

being-in-the-world. Moreover, the secondary verbal and concep-

tual task of reintegrating the various bits and pieces will parallel

the despairing efforts of the schizophrenic to put his disintegrated

self and world together again. In short, we have an already shat-

tered Humpty Dumpty who cannot be put together again by any

number of hyphenated or compound words: psycho-physical,

psycho-somatic, psycho-biological, psycho-pathological, psycho-

social, etc., etc.

If this is so, it may be that a look at how such schizoid theory

originates would be highly relevant to the understanding of schi-

zoid experience. In the following section, I shall use a pheno-

menological method to try to answer this question.

Man's being (I shall use 'being' subsequently to denote simply

all that a man is) can be seen from different points of view and one

or other aspect can be made the focus of study. In particular, man

can be seen as person or thing. Now, even the same thing, seen

from different points of view, gives rise to two entirely different

descriptions, and the descriptions give rise to two entirely different

theories, and the theories result in two entirely different sets of

action. The initial way we see a thing determines all our subsequent

dealings with it. Let us consider an equivocal or ambiguous figure:

Foundations for a science of persons 21

In this figure, there is one thing on the paper which can be seen as a

vase or as two faces turned towards each other. There are not two

things on the paper: there is one thing there, but, depending on

how it strikes us, we can see two different objects. The relation of

the parts to the whole in the one object is quite different from the

relation of the parts to the whole in the other. If we describe one of

the faces seen we would describe, from top to bottom, a forehead,

a nose, an upper lip, a mouth, a chin, and a neck. Although we have

described the same line, which, if seen differently, can be the one

side of a vase, we have not described the side of a vase but the out-

line of a face.

Now, if you are sitting opposite me, I can see you as another

person like myself; without you changing or doing anything differ-

ently, I can now see you as a complex physical-chemical system,

perhaps with its own idiosyncrasies but chemical none the less for

that; seen in this way, you are no longer a person but an organism.

Expressed in the language of existential phenomenology, the other,

as seen as a person or as seen as an organism, is the object of differ-

ent intentional acts. There is no dualism in the sense of the co-

existence of two different essences or substances there in the object,

psyche and soma; there are two different experiential Gestalts:

person and organism.

One's relationship to an organism is different from one's relation

to a person. One's description of the other as organism is as differ-

ent from one's description of the other as person as the description

of side of vase is from profile of face; similarly, one's theory of the

other as organism is remote from any theory of the other as person.

One acts towards an organism differently from the way one acts

towards a person. The science of persons is the study of human

beings that begins from a relationship with the other as person and

proceeds to an account of the other still as person.

For example, if one is listening to another person talking, one

may either (a) be studying verbal behaviour in terms of neural pro-

cesses and the whole apparatus of vocalizing, or (b) be trying to

understand what he is saying. In the latter case, an explanation of

verbal behaviour in terms of the general nexus of organic changes

that must necessarily be going on as a conditio sine qua non of his

verbalization, is no contribution to a possible understanding of

22 The Divided Self

what the individual is saying. Conversely, an understanding of

what the individual is saying does not contribute to a knowledge

of how his brain cells are metabolizing oxygen. That is, an under-

standing of what he is saying is no substitute for an explanation of

the relevant organismic processes, and vice versa. Again, there is

no question here or anywhere of a mind-body dualism. The two

accounts, in this case personal and organismic, taken up in respect

to speech or any other observable human activity, are each the

outcome of one's initial intentional act; each intentional act leads

in its own direction and yields its own results. One chooses the

point of view or intentional act within the overall context of what

one is 'after' with the other. Man as seen as an organism or man as

seen as a person discloses different aspects of the human reality to

the investigator. Both are quite possible methodologically but one

must be alert to the possible occasion for confusion.

The other as person is seen by me as responsible, as capable of

choice, in short, as a self-acting agent. Seen as an organism, all

that goes on in that organism can be conceptualized at any level of

complexity - atomic, molecular, cellular, systemic, or organismic.

Whereas behaviour seen as personal is seen in terms of that per-

son's experience and of his intentions, behaviour seen organismi-

cally can only be seen as the contraction or relaxation of certain

muscles, etc. Instead of the experience of sequence, one is con-

cerned with a sequence of processes. In man seen as an organism,

therefore, there is no place for his desires, fears, hope or despair as

such. The ultimates of our explanations are not his intentions to

his world but quanta of energy in an energy system.

Seen as an organism, man cannot be anything else but a complex

of things, of its, and the processes that ultimately comprise an

organism are it-processes. There is a common illusion that one

somehow increases one's understanding of a person if one can

translate a personal understanding of him into the impersonal

terms of a sequence or system of it-processes. Even in the absence

of theoretical justifications, there remains a tendency to translate

our personal experience of the other as a person into an account of

him that is depersonalized. We do this in some measure whether

we use a machine analogy or a biological analogy in our 'explana-

tion'. It should be noted that I am not here objecting to the use of

Foundations for a science of persons 23

mechanical or biological analogies as such, nor indeed to the inten-

tional act of seeing man as a complex machine or as an animal. My

thesis is limited to the contention that the theory of man as person

loses its way if it falls into an account of man as a machine or man

as an organismic system of it-processes. The converse is also true

(see Brierley, 1951).

It seems extraordinary that whereas the physical and biological

sciences of it-processes have generally won the day against tenden-

cies to personalize the world of things or to read human intentions

into the animal world, an authentic science of persons has hardly

got started by reason of the inveterate tendency to depersonalize or

reify persons.

In the following pages, we shall be concerned specifically with

people who experience themselves as automata, as robots, as bits

of machinery, or even as animals. Such persons are rightly regarded

as crazy. Yet why do we not regard a theory that seeks to transmute

persons into automata or animals as equally crazy ? The experience

of oneself and others as persons is primary and self-validating. It

exists prior to the scientific or philosophical difficulties about how

such experience is possible or how it is to be explained.

Indeed, it is difficult to explain the persistence in all our thinking

of elements of what MacMurray has called the 'biological anal-

ogy': 'We should expect,' writes MacMurray (1957), 'that the

emergence of a scientific psychology would be paralleled by a

transition from an organic to a personal . . . conception of unity'

(p. 37), that we should be able to think of the individual man as

well as to experience him neither as a thing nor as an organism but

as a person and that we should have a way of expressing that form

of unity which is specifically personal. The task in the following

pages is, therefore, the formidable one of trying to give an account

of a quite specifically personal form of depersonalization and dis-

integration at a time when the discovery of 'the logical form

through which the unity of the personal can be coherently con-

ceived' (ibid.) is still a task for the future.

There are, of course, many descriptions of depersonalization

and splitting in psychopathology. However, no psychopatho-

logical theory is entirely able to surmount the distortion of the

person imposed by its own premisses even though it may seek to

24 The Divided Self

deny these very premisses. A psychopathology worthy of its name

must presuppose a 'psyche' (mental apparatus or endopsychic

structure). It must presuppose that the objectification, with or

without reification imposed by thinking in terms of a fictional

'thing' or system, is an adequate conceptual correlate of the other

as a person in action with others. Moreover, it must presuppose

that its conceptual model has a way of functioning analogous to the

way that an organism functions in health and a way of functioning

analogous to an organism's way of functioning when physically

diseased. However pregnant with partial analogies such compari-

sons are, psychopathology by the very nature of its basic approach

precludes the possibility of understanding a patient's disorganiza-

tion as a failure to achieve a specifically personal form of unity. It

is like trying to make ice by boiling water. The very existence of

psychopathology perpetuates the very dualism that most psycho-

pathologists wish to avoid and that is clearly false. Yet this dualism

cannot be avoided within the psychopathological frame of refer-

ences except by falling into a monism that reduces one term to

the other, and is simply another twist to a spiral of falsity.

It may be maintained that one cannot be scientific without

retaining one's 'objectivity'. A genuine science of personal exist-

ence must attempt to be as unbiased as possible. Physics and the

other sciences of things must accord the science of persons the

right to be unbiased in a way that is true to its own field of study.

If it is held that to be unbiased one should be 'objective' in the

sense of depersonalizing the person who is the 'object' of our study,

any temptation to do this under the impression that one is thereby

being scientific must be rigorously resisted. Depersonalization in

a theory that is intended to be a theory of persons is as false as

schizoid depersonalization of others and is no less ultimately an

intentional act. Although conducted in the name of science, such

reification yields false 'knowledge'. It is just as pathetic a fallacy

as the false personalization of things.

It is unfortunate that personal and subjective are words so

abused as to have no power to convey any genuine act of seeing

the other as person (if we mean this we have to revert to 'objec-

tive'), but imply immediately that one is merging one's own feelings

and attitudes into one's study of the other in such a way as to

Foundations for a science of persons 25

distort our perception of him. In contrast to the reputable 'objec-

tive' or 'scientific', we have the disreputable 'subjective', 'intui-

tive', or, worst of all, 'mystical'. It is interesting, for example, that

one frequently encounters 'merely' before subjective, whereas it is

almost inconceivable to speak of anyone being 'merely' objective.

The greatest psychopathologist has been Freud. Freud was a

hero. He descended to the 'Underworld' and met there stark

terrors. He carried with him his theory as a Medusa's head which

turned these terrors to stone. We who follow Freud have the

benefit of the knowledge he brought back with him and conveyed

to us. He survived. We must see if we now can survive without

using a theory that is in some measure an instrument of defence.

THE RELATIONSHIP TO THE PATIENT AS PERSON

OR AS THING

In existential phenomenology the existence in question may be

one's own or that of the other. When the other is a patient, exis-

tential phenomenology becomes the attempt to reconstruct the

patient's way of being himself in his world, although, in the thera-

peutic relationship, the focus may be on the patient's way of being-

with-me.

Patients present themselves to a psychiatrist with complaints

that may be anywhere in the range between the most apparently

localized difficulty ('I have a reluctance for jumping from a plane'),

to the most diffuse difficulty possible ('I can't say why I've come

really. I suppose it is just me that's not right'). However, no matter

how circumscribed or diffuse the initial complaint may be, one

knows that the patient is bringing into the treatment situation,

whether intentionally or unintentionally, his existence, his whole

being-in-his-world. One knows also that every aspect of his being is

related in some way to every other aspect, although the manner in

which these aspects are articulated may be by no means clear. It is

the task of existential phenomenology to articulate what the other's

'world' is and his way of being in it. Right at the start, my own

idea of the scope or extension of a man's being may not coincide

with his, nor for that matter with that of other psychiatrists. I, for

instance, regard any particular man as finite, as one who has had a

26 The Divided Self

beginning and who will have an end. He has been born, and he is

going to die. In the meantime, he has a body that roots him to this

time and this place. These statements I believe to be applicable to

each and every particular man. I do not expect to re-verify them

each time I meet another person. Indeed, they cannot be proved or

falsified. I have had a patient whose notion of the horizons of his

own being extended beyond birth and death: 'in fact' and not just

'in imagination' he said he was not essentially bound to one time

and one place. I did not regard him as psychotic, nor could I prove

him wrong, even if I cared to. Nevertheless, it is of considerable

practical importance that one should be able to see that the con-

cept and/or experience that a man may have of his being may be

very different from one's own concept or experience of his being.

In these cases, one has to be able to orientate oneself as a person in

the other's scheme of things rather than only to see the other as an

object in one's own world, i.e. within the total system of one's own

reference. One must be able to effect this reorientation without

prejudging who is right and who is wrong. The ability to do this is

an absolute and obvious prerequisite in working with psychotics.

There is another aspect of man's being which is the crucial one

in psychotherapy as contrasted with other treatments. This is that

each and every man is at the same time separate from his fellows

and related to them. Such separateness and relatedness are mutu-

ally necessary postulates. Personal relatedness can exist only

between beings who are separate but who are not isolates. We are

not isolates and we are not parts of the same physical body. Here

we have the paradox, the potentially tragic paradox, that our

relatedness to others is an essential aspect of our being, as is our

separateness, but any particular person is not a necessary part of

our being.

Psychotherapy is an activity in which that aspect of the patient's

being, his relatedness to others, is used for therapeutic ends. The

therapist acts on the principle that, since relatedness is potentially

present in everyone, then he may not be wasting his time in sitting

for hours with a silent catatonic who gives every evidence that he

does not recognize his existence.

2 The existential-phenomenological

foundations for the understanding

of psychosis

There is a further characteristic of the current psychiatric jargon.

It speaks of psychosis as a social or biological failure of adjustment,

or mal-adaptation of a particularly radical kind, of loss of contact

with reality, of lack of insight. As van den Berg (1955) has said,

this jargon is a veritable 'vocabulary of denigration'. The deni-

gration is not moralistic, at least in a nineteenth-century sense; in

fact, in many ways this language is the outcome of efforts to

avoid thinking in terms of freedom, choice, responsibility. But it

implies a certain standard way of being human to which the

psychotic cannot measure up. I do not, in fact, object to all the

implications in this 'vocabulary of denigration'. Indeed, I feel we

should be more frank about the judgements we implicitly make

when we call someone psychotic. When I certify someone insane,

I am not equivocating when I write that he is of unsound mind,

may be dangerous to himself and others, and requires care and

attention in a mental hospital. However, at the same time, I am

also aware that, in my opinion, there are other people who are

regarded as sane, whose minds are as radically unsound, who may

be equally or more dangerous to themselves and others and

whom society does not regard as psychotic and fit persons to be

in a madhouse. I am aware that the man who is said to be deluded

may be in his delusion telling me the truth, and this in no equivocal

or metaphorical sense, but quite literally, and that the cracked

mind of the schizophrenic may let in light which does not enter the

intact minds of many sane people whose minds are closed.

Ezekiel, in Jaspers's opinion, was a schizophrenic.

I must confess here to a certain personal difficulty I have in being

28 The Divided Self

a psychiatrist, which lies behind a great deal of this book. This

is that except in the case of chronic schizophrenics I have difficulty

in actually discovering the 'signs and symptoms' of psychosis in

persons I am myself interviewing. I used to think that this was

some deficiency on my part, that I was not clever enough to get

at hallucinations and delusions and so on. If I compared my experi-

ence with psychotics with the accounts given of psychosis in the

standard textbooks, I found that the authors were not giving a

description of the way these people behaved with me. Maybe they

were right and I was wrong. Then I thought that maybe they

were wrong. But this is just as untenable. The following seems to

be a statement of fact:

The standard texts contain the descriptions of the behaviour of

people in a behavioural field that includes the psychiatrist. The

behaviour of the patient is to some extent a function of the

behaviour of the psychiatrist in the same behavioural field. The

standard psychiatric patient is a function of the standard psychia-

trist, and of the standard mental hospital. The figured base, as it

were, which underscores all Bleuler's great description of schizo-

phrenics is his remark that when all is said and done they were

stranger to him than the birds in his garden.

Bleuler, we know, approached his patients as a non-psychiatric

clinician would approach a clinical case, with respect, courtesy,

consideration, and scientific curiosity. The patient, however, is

diseased in a medical sense, and it is a matter of diagnosing his

condition, by observing the signs of his disease. This approach is

regarded as so self-evidently justifiable by so many psychiatrists

that they may find it difficult to know what I am getting at. There

are now, of course, many other schools of thought, but this is still

the most extensive one in this country. It certainly is the approach

that is taken for granted by non-medical people. I am speaking

here all the time of psychotic patients (i.e. as most people immedi-

ately say to themselves, not you or me). Psychiatrists still hang on

to it in practice even though they pay lip-service to incompatible

views, outlook, and manner. Now, there is so much that is good

and worth while in this, so much also that is safe in it, that anyone

has a right to examine most closely any view that a clinical pro-

fessional attitude of this kind may not be all that is required, or

Foundations for the understanding of psychosis 29

may even be misplaced in certain circumstances. The difficulty

consists not simply in noticing evidence of the patient's feelings as

they reveal themselves in his behaviour. The good medical

clinician will allow for the fact that if his patient is anxious, his

blood pressure may be somewhat higher than usual, his pulse may

be rather faster than normal, and so on. The crux of the matter is

that when one examines 'a heart', or even the whole man as an

organism, one is not interested in the nature of one's own personal

feelings about him; whatever these may be are irrelevant, dis-

counted. One maintains a more or less standard professional

outlook and manner.

That the classical clinical psychiatric attitude has not changed in

principle since Kraepelin can be seen by comparing the following

with the similar attitude of any recent British textbook of psy-

chiatry (e.g. Mayer-Gross, Slater and Roth).

Here is Kraepelin's (1905) account to a lecture-room of his

students of a patient showing the signs of catatonic excitement:

The patient I will show you today has almost to be carried into the

rooms, as he walks in a straddling fashion on the outside of his feet.

On coming in, he throws off his slippers, sings a hymn loudly, and then

cries twice (in English),' My father, my real father!' He is eighteen years

old, and a pupil of the Oberrealschule (higher-grade modern-side

school), tall, and rather strongly built, but with a pale complexion, on

which there is very often a transient flush. The patient sits with his eyes

shut, and pays no attention to his surroundings. He does not look up

even when he is spoken to, but he answers beginning in a low voice, and

gradually screaming louder and louder. When asked where he is, he

says, 'You want to know that too? I tell you who is being measured

and is measured and shall be measured. I know all that, and could tell

you, but I do not want to.' When asked his name, he screams, 'What is

your name? What does he shut? He shuts his eyes. What does he hear?

He does not understand; he understands not. How? Who? Where?

When ? What does he mean? When I tell him to look he does not look

properly. You there, just look! What is it? What is the matter? Attend;

he attends not. I say, what is it, then? Why do you give me no answer?

Are you getting impudent again? How can you be so impudent? I'm

coming! I'll show you! You don't whore for me. You mustn't be smart

either; you're an impudent, lousy fellow, such an impudent, lousy fel-

low I've never met with. Is he beginning again? You understand nothing

30 The Divided Self

at all, nothing at all; nothing at all does he understand. If you follow

now, he won't follow, will not follow. Are you getting still more impu-

dent? Are you getting impudent still more? How they attend, they do

attend,' and so on. At the end, he scolds in quite inarticulate sounds.

Kraepelin notes here among other things the patient's 'inaccessi-

bility':

Although he undoubtedly understood all the questions, he has not

given us a single piece of useful information. His talk w a s . . . only a series

of disconnected sentences having no relation whatever to the general

situation (1905, pp. 79-80, italics my own).

Now there is no question that this patient is showing the 'signs'

of catatonic excitement. The construction we put on this behaviour

will, however, depend on the relationship we establish with the

patient, and we are indebted to Kraepelin's vivid description

which enables the patient to come, it seems, alive to us across

fifty years and through his pages as though he were before us.

What does this patient seem to be doing? Surely he is carrying on

a dialogue between his own parodied version of Kraepelin, and

his own defiant rebelling self. 'You want to know that too? I tell

you who is being measured and is measured and shall be measured.

I know all that, and I could tell you, but I do not want to.' This

seems to be plain enough talk. Presumably he deeply resents this

form of interrogation which is being carried out before a lecture-

room of students. He probably does not see what it has to do with

the things that must be deeply distressing him. But these things

would not be 'useful information' to Kraepelin except as further

'signs' of a 'disease'.

Kraepelin asks him his name. The patient replies by an exas-

perated outburst in which he is now saying what he feels is the

attitude implicit in Kraepelin's approach to him: What is your

name? What does he shut? He shuts his eyes.... Why do you give

me no answer? Are you getting impudent again? You don't

whore for me? (i.e. he feels that Kraepelin is objecting because he

is not prepared to prostitute himself before the whole classroom

of students), and so on . . . such an impudent, shameless, miser-

able, lousy fellow I've never met with . . . etc.

Now it seems clear that this patient's behaviour can be seen in

Foundations for the understanding of psychosis 31

at least two ways, analogous to the ways of seeing vase or face.

One may see his behaviour as 'signs' of a 'disease'; one may see his

behaviour as expressive of his existence. The existential-pheno-

menological construction is an inference about the way the other

is feeling and acting. What is the boy's experience of Kraepelin?

He seems to be tormented and desperate. What is he 'about ' in

speaking and acting in this way ? He is objecting to being measured

and tested. He wants to be heard.

INTERPRETATION AS A FUNCTION OF THE

RELATIONSHIP WITH THE PATIENT

The clinical psychiatrist, wishing to be more 'scientific' or

'objective', may propose to confine himself to the 'objectively'

observable behaviour of the patient before him. The simplest

reply to this is that it is impossible. To see 'signs' of 'disease' is not

to see neutrally. Nor is it neutral to see a smile as contractions of

the circumoral muscles (Merleau-Ponty, 1953). We cannot help

but see the person in one way or other and place our constructions

or interpretations on 'his ' behaviour, as soon as we are in a rela-

tionship with him. This is so, even in the negative instance where

we are drawn up or baffled by an absence of reciprocity on the

part of the patient, where we feel there is no one there who is res-

ponding to our approaches. This is very near the heart of our

problem.

The difficulties facing us here are somewhat analogous to the

difficulties facing the expositor of hieroglyphics, an analogy

Freud was fond of drawing; they are, if anything, greater. The

theory of the interpretation or deciphering of hieroglyphics and

other ancient texts has been carried further forward and made

more explicit by Dilthey in the last century than the theory of the

interpretation of psychotic 'hieroglyphic' speech and actions. It

may help to clarify our position if we compare our problem with

that of the historian as expounded by Dilthey.* In both cases, the

essential task is one of interpretation.

* The immediate source for the Dilthey quotations in the following pas-sage is Bultmann's 'The problem of hermeneutics' {Essays, 1955, pp.234-61).

32 The Divided Self

Ancient documents can be subjected to a formal analysis in

terms of structure and style, linguistic traits, and characteristic

idiosyncrasies of syntax, etc. Clinical psychiatry attempts an

analogous formal analysis of the patient's speech and behaviour.

This formalism, historical or clinical, is clearly very limited in

scope. Beyond this formal analysis, it may be possible to shed

light on the text through a knowledge of the nexus of socio-his-

torical conditions from which it arose. Similarly, we usually wish

to extend as far as we can our formal and static analysis of isolated

clinical 'signs' to an understanding of their place in the person's

life history. This involves the introduction of dynamic-genetic

hypotheses. However, historical information, per se, about ancient

texts or about patients, will help us to understand them better

only if we can bring to bear what is often called sympathy, or,

more intensively, empathy.

When Dilthey, therefore, 'characterizes the relationship between

the author and the expositor as the conditioning factor for the

possibility of the comprehension of the text, he has, in fact, laid

bare the presupposition of all interpretation which has compre-

hension as its basis' (Bultmann, op. cit.).

We explain [writes Dilthey] by means of purely intellectual processes,but we understand by means of the cooperation of all the powers of themind in comprehension. In understanding we start from the connectionof the given, living whole, in order to make the past comprehensible interms of it.

Now, our view of the other depends on our willingness to

enlist all the powers of every aspect of ourselves in the act of com-

prehension. It seems also that we require to orientate ourselves to

this person in such a way as to leave open to us the possibility of

understanding him. The art of understanding those aspects of an

individual's being which we can observe, as expressive of his

mode of being-in-the-world, requires us to relate his actions to

his way of experiencing the situation he is in with us. Similarly it

is in terms of his present that we have to understand his past, and

not exclusively the other way round. This again is true even in the

negative instances when it may be apparent through his behaviour

that he is denying the existence of any situation he may be in with

Foundations for the understanding of psychosis 33

us, for instance, when we feel ourselves treated as though we did

not exist, or as existing only in terms of the patient's own wishes

or anxieties. It is not a question here of affixing predetermined

meanings to this behaviour in a rigid way. If we look at his actions

as 'signs' of a 'disease', we are already imposing our categories of

thought on to the patient, in a manner analogous to the way we

may regard him as treating us; and we shall be doing the same if

we imagine that we can 'explain' his present as a mechanical

resultant of an immutable 'past'.

If one is adopting such an attitude towards a patient, it is hardly

possible at the same time to understand what he may be trying to

communicate to us. To consider again the instance of listening

to someone speaking, if I am sitting opposite you and speaking to

you, you may be trying (i) to assess any abnormalities in my speech,

or (ii) to explain what I am saying in terms of how you are imagin-

ing my brain cells to be metabolizing oxygen, or (iii) to discover

why, in terms of past history and socio-economic background,

I should be saying these things at this time. Not one of the answers

that you may or may not be able to supply to these questions will

in itself supply you with a simple understanding of what I am

getting at.

It is just possible to have a thorough knowledge of what has

been discovered about the hereditary or familial incidence of

manic-depressive psychosis or schizophrenia, to have a facility in

recognizing schizoid 'ego distortion' and schizophrenic ego

defects, plus the various 'disorders' of thought, memory, percep-

tions, etc., to know, in fact, just about everything that can be

known about the psychopathology of schizophrenia or of schizo-

phrenia as a disease without being able to understand one single

schizophrenic. Such data are all ways of not understanding him. To

look and to listen to a patient and to see 'signs' of schizophrenia

(as a 'disease') and to look and to listen to him simply as a human

being are to see and to hear in as radically different ways as when

one sees, first the vase, then the faces in the ambiguous picture.

Of course, as Dilthey says, the expositor of a text has a right to

presume that despite the passage of time, and the wide divergence

of world view between him and the ancient author, he stands in a

not entirely different context of living experience from the original

34 The Divided Self

writer. He exists, in the world, like the other, as a permanent

object in time and place, with others like himself. It is just this

presupposition that one cannot make with the psychotic. In this

respect, there may be a greater difficulty in understanding the

psychotic in whose presence we are here and now, than there is in

understanding the writer of a hieroglyphic dead for thousands of

years. Yet the distinction is not an essential one. The psychotic,

after all, as Harry Stack Sullivan has said, is more than anything

else 'simply human'. The personalities of doctor and psychotic,

no less than the personalities of expositor and author, do not stand

opposed to each other as two external facts that do not meet and

cannot be compared. Like the expositor, the therapist must have

the plasticity to transpose himself into another strange and even

alien view of the world. In this act, he draws on his own psychotic

possibilities, without forgoing his sanity. Only thus can he arrive

at an understanding of the patient's existential position.

I think it is clear that by 'understanding' I do not mean a

purely intellectual process. For understanding one might say love.

But no word has been more prostituted. What is necessary,

though not enough, is a capacity to know how the patient is

experiencing himself and the world, including oneself. If one

cannot understand him, one is hardly in a position to begin to

'love' him in any effective way. We are commanded to love our

neighbour. One cannot, however, love this particular neighbour

for himself without knowing who he is. One can only love his

abstract humanity. One cannot love a conglomeration of 'signs

of schizophrenia'. No one has schizophrenia, like having a cold.

The patient has not 'got' schizophrenia. He is schizophrenic. The

schizophrenic has to be known without being destroyed. He will

have to discover that this is possible. The therapist's hate as well

as his love is, therefore, in the highest degree relevant. What the

schizophrenic is to us determines very considerably what we are

to him, and hence his actions. Many of the textbook 'signs' of

schizophrenia vary from hospital to hospital and seem largely

a function of nursing. Some psychiatrists observe certain schizo-

phrenic 'signs' much less than others.*

* There is now an extensive literature to support this view. See, for example,'In the Mental Hospital' (articles from The Lancet, 1955-6).

Foundations for the understanding of psychosis 35

I think, therefore, that the following statement by Frieda

Fromm-Reichmann is indeed true, however disturbing it is:

. . . psychiatrists can take it for granted now that in principle a workable

doctor-patient relationship can be established with the schizophrenic

patient. If and when this seems impossible, it is due to the doctor's

personality difficulties, not to the patient's psychopathology (1952,

p. 91).

Of course, as with Kraepelin's catatonic young man, the

individual reacts and feels towards oneself only partially in terms

of the person one takes oneself to be and partially in terms of his

phantasy of what one is. One tries to make the patient see that his

way of acting towards oneself implies a phantasy of one kind or

another, which, most likely, he does not fully recognize (of which

he is unconscious), but which, nevertheless, is a necessary postu-

late if one is to make any sense of this way of conducting himself.

When two sane persons are together one expects that A will

recognize B to be more or less the person B takes himself to be,

and vice versa. That is, for my part, I expect that my own definition

of myself should, by and large, be endorsed by the other person,

assuming that I am not deliberately impersonating someone else,

being hypocritical, lying, and so on.* Within the context of mutual

sanity there is, however, quite a wide margin for conflict, error,

misconception, in short, for a disjunction of one kind or another

between the person one is in one's own eyes (one's being-for-

oneself) and the person one is in the eyes of the other (one's being-

for-the-other), and, conversely, between who or what he is for me

and who or what he is for himself; finally, between what one

imagines to be his picture of oneself and his attitude and intentions

towards oneself, and the picture, attitude, and intentions he has

in actuality towards oneself, and vice versa.

That is to say, when two sane persons meet, there appears to

be a reciprocal recognition of each other's identity. In this mutual

recognition there are the following basic elements:

(a) I recognize the other to be the person he takes himself to be.

(b) He recognizes me to be the person I take myself to be.

* There is the story of the patient in a lie-detector who was asked if he wasNapoleon. He replied, 'No'. The lie-detector recorded that he was lying.

36 The Divided Self

Each has his own autonomous sense of identity and his own

definition of who and what he is. You are expected to be able to

recognize me. That is, I am accustomed to expect that the person

you take me to be, and the identity that I reckon myself to have,

will coincide by and large: let us say simply 'by and large', since

there is obviously room for considerable discrepancies.

However, if there are discrepancies of a sufficiently radical kind

remaining after attempts to align them have failed, there is no

alternative but that one of us must be insane. I have no difficulty

in regarding another person as psychotic, if for instance:

he says he is Napoleon, whereas I say he is not;

or if he says I am Napoleon, whereas I say I am not;

or if he thinks that I wish to seduce him, whereas I think that I

have given him no grounds in actuality for supposing that such is

my intention;

or if he thinks that I am afraid he will murder me, whereas I am

not afraid of this, and have given him no reason to think that I am.

I suggest, therefore, that sanity or psychosis is tested by the degree

of conjunction or disjunction between two persons where the one is

sane by common consent.

The critical test of whether or not a patient is psychotic is a

lack of congruity, an incongruity, a clash, between him and me.

The 'psychotic' is the name we have for the other person in a

disjunctive relationship of a particular kind. It is only because of

this interpersonal disjunction that we start to examine his urine,

and look for anomalies in the graphs of the electrical activity of

his brain.

It is worth while at this point to probe a little farther into what is

the nature of the barrier or disjunction between the sane and

the psychotic.

If, for instance, a man tells us he is 'an unreal man', and if he is

not lying, or joking, or equivocating in some subtle way, there is

no doubt that he will be regarded as deluded. But, existentially,

what does this delusion mean? Indeed, he is not joking or pre-

tending. On the contrary, he goes on to say that he has been pre-